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Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) is a label that mental health professionals use. It describes the behaviour of certain people who have serious problems in living.

People with this diagnosis often experience stronger emotions than the average person. They may often feel afraid or desperate and do impulsive things as a result. They may have problems getting and keeping good relationships because of their feelings of anger or fear are so strong.

People with BPD may think others are trying to take advantage of them or have their feelings easily hurt. Also they may have a feeling of emptiness or sadness inside that makes them want to die or self-harm. Painful emotions tend to cloud their judgement so that decision-making is impaired.

People with BPD also lack the skills to understand and cope with their emotional experiences. They tend to be confused by them or reject their emotions altogether. Because of this, people with BPD often feel that life is one crisis after another. Mood swings and the behaviours that come from them may make it difficult to live a good life.

Borderline personality disorder is a complex diagnosis. This is because the symptoms look different from one person to another. To get a formal diagnosis, a person needs to show signs of at least five of these nine symptoms on a frequent basis:

Intense worries about abandonment and strong efforts to avoid it

Unpredictable, rocky relationships

Uncertainty about self-identity

Reckless, risky behaviours

Self-harming behaviours

Highly volatile emotions

Profound feelings of hollowness or emptiness

Easily provoked rage

Short-term flights from reality.

How does BPD develop?

It is thought that symptoms develop in childhood. They are based on a combination of:

Inherited biology, which may leave the individual more vulnerable to emotional extremes.

Neurobiology (differences in some structures in the brain).

The environment – essentially a place where a child was unable to develop and thrive, e.g. due to neglect or abuse. (However, even ‘normal’ family environments are sometimes inadequate for biologically vulnerable individuals).

The developing child is ill-equipped to cope with painful emotions and thoughts. To try to solve life’s problems, they develop self-defeating behaviours.

Treatment

It’s important to keep in mind that Borderline Personality Disorder and the person is not the same thing. BPD is something people have, not something they are.

Generally life with BPD is more difficult. It’s harder to live life to its full. There is also a greater risk of death by suicide, sometimes accidently.

Medication alone is not enough to overcome the symptoms of BPD. Whilst therapy is not essential in the recovery process, it has been found to help. For many people, psychological treatments work but they take time and effort.

At Southern Health, our first line of psychological therapy is usually Dialectical Behaviour Therapy (DBT). Either in full or in an adapted form, usually termed Emotional Coping Skills (ECS). These both involve weekly skills groups alongside individual therapy. Other helpful interventions include developing a ‘My Crisis Plan’ and second stage therapies also include Cognitive Analytic Therapy.

So, how will therapy help? It will help a person to:

Live in the present. Not being overwhelmed by regrets of the past and worries about the future.

Learn skills in how to regulate emotions, thoughts, behaviours.

Identify situations when skills will be useful.

Practice and problem solve the use of these skills, identifying blocks and overcoming these.

Identify goals and reasons to try the new skills, as well as helping during difficult times.